J Breast Cancer.  2009 Jun;12(2):73-78. 10.4048/jbc.2009.12.2.73.

Radiation Pneumonitis after Adjuvant Radiotherapy for Breast Cancer: A Volumetric Analysis Using CT Simulator

• Chie EK
• Shin KH
• Kim DY
• Kim TH
• Kang HS
• Lee ES
• Cho KH

• KMID: 2175198
• DOI: http://doi.org/10.4048/jbc.2009.12.2.73

Abstract

PURPOSE: To assess clinical factors and volumetric parameters associated with clinically significant symptomatic radiation pneumonitis (RP), which requires steroid medication after radiotherapy (RT).
METHODS
Medical records of 204 irradiated breast cancer patients were reviewed. Percent lung volume (PLV) receiving more than 20 Gy was measured from CT-based treatment plan and was correlated with the central lung distance (CLD) of local and regional fields. PLV was also evaluated as a predictive factor of symptomatic RP, along with other previously reported clinical factors.
RESULTS
Average (+/-standard deviation) actual irradiated lung volume and PLV for breast/chest wall irradiation were 169 (+/-50.6) cm3 and 14.9 (+/-3.8)%, respectively. Addition of regional irradiation resulted in increase of 183 (+/-80.2) cm3 in actual irradiated lung volume and 16.5 (+/-6.2)% in PLV. The correlation between CLD of the local fields and PLV was significant, with 1 cm of CLD corresponding to approximately 6% of PLV. CLD of the regional field was also significantly associated with PLV: a CLD of 3 cm corresponds to a PLV of approximately 13%; a CLD of 4 cm, approximately 17%; and a CLD of 5 cm, approximately 21%. RP developed in 11 patients (5.4%). There was an increased incidence of RP among patients who underwent local RT vs local and regional RT (2.4% vs 12.1%, p=0.0192). In terms of PLV, total PLV > or =23% was associated with the development of RP (p=0.0467). Previously reported clinical factors failed to show statistically significant association.
CONCLUSION
Correlation between CLD and PLV for local and regional fields was significant on volumetric analysis. Although symptomatic RP requiring steroid medication was a rare complication, regional irradiation increased the incidence of RP, and such relationship can be expressed with a volumetric parameter of PLV.

Keyword

Breast neoplasms; Radiation pneumonitis; Volumetric analysis

MeSH Terms

Breast
Breast Neoplasms
Humans
Incidence
Lung
Medical Records
Radiation Pneumonitis
Radiotherapy, Adjuvant

Figure

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  Figure 1 Typical local fields using photon half beam and a dose-volume histogram.

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  Figure 2 (A) Central lung distance (CLD) in the local field. (B) CLD in the regional field.

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  Figure 3 (A) Scattergram for the local field. (B) Scattergram for the regional field.

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